Football Head Injuries: Can Concussions Really Be Stopped by Modern-Day Helmets?

Andy Sandkamp's teenage son practiced a football drill in September 2007 known as the "cadet maker," a maneuver in which a linebacker runs full-speed into a running back, who is blocked by two linemen. As his son attempted to break through the two-person shield and make the tackle, everything changed.

His son was "down and out" immediately after the hit, Sandkamp said. While he never fully lost consciousness, Sandkamp said his son had convulsions on the field and felt dizzy and disoriented. Sandkamp asked that his son's name and age not be published to protect his privacy.

Doctors diagnosed the young man with a concussion. Later, however, Sandkamp and the physicians discovered that it wasn't the first time his son had suffered such head trauma. After a battery of tests, Sandkamp, who lives in St. Paul, Minn., said neurologists told him that his son had actually suffered his first minor concussion during practice a week earlier.

"I really don't want this to happen to another kid, where the first concussion goes unidentified, and they're at greater risk for a more severe, second concussion," Sandkamp said.

Sandkamp said his son suffered from severe short-term memory loss for six months to a year after the accident. His son had been a straight-A student, but his grades plummeted during his senior year after the violent blow to his head.

Concussions and helmet safety in football have become hot-button issues -- and while medical experts, coaches and now even lawmakers are getting involved in preventing brain injury, many experts say the science simply isn't available to fully prevent concussions on the football field. At least not quite yet.

On Wednesday, Brain Injury Awareness Day, New Mexico Senator Tom Udall and New Jersey Rep. Bill Pascrell unveiled a bipartisan bill, called the Children's Sports Athletic Equipment Safety Act. It aims to protect young football players, ages 18 and younger, from the dangers of sports-related brain injuries.

The legislation specifically focuses on the use of older helmets, which gradually wear out and offer less head and brain protection as years of hard play go by. If passed, the bill would order that new and reconditioned helmets must be tested by a third party to ensure their safety. The legislation also specifically addresses the prevention of concussions in children younger than 12.

"These are good steps to take for player safety," said Sandkamp. "Helmets definitely reduce the incidence of concussion. They won't take care of the whole problem, but they certainly help."

The proposed bill would give helmet companies nine months to improve standards voluntarily. If the standards still lacked proper safety measures, the Consumer Product Safety Commission would then be required to set mandatory guidelines.

"Football fans are wondering…if there will be an NFL season this fall, but we're here today to talk about a more important crisis: a concussion crisis," said Udall at the press conference. "I'm talking about a brain injury epidemic that affects 4.5 million football players who are still too young to play in the NFL."

Udall said that there are an estimated 100,000 helmets being used today that are more than a decade old — and kids are the ones who will wear those helmets.

"These facts highlight the concern about the voluntary standards for new and reconditioned football helmets," said Udall.

Dr. Gregory O'Shanick, president and medical director of the Center for Neurorehabilitation Services in Richmond, Va., said that most helmets are single-use items and must be monitored to prevent injury.

"They are designed to either increase stopping distance with foam inserts or dissipate the kinetic force by fracturing the shell and thus preventing force transmission into the skull and brain," said O'Shanick. "As with children's safety seats for cars, once they have been in an impact situation, their structural properties are changed and they afford less protection."

The National Athletic Equipment Reconditioning Association, or NAERA, refurbishes about 1.7 million helmets a year that are usually at least a year old. Ed Fischer, executive director of the NAERA, announced last week that, beginning Sept. 1, 2011, the company will not certify helmets that are more than 10 years old. While the helmets are usually only a couple of years old, Fisher said he has refurbished helmets that were up to 20 years old.

As a former football coach, Fisher said that he often looks at kids' helmets and wonders how old they might be.

"I think this is a really good thing to happen for player safety, from pee wee players to the NFL," said Fisher.

Nuts and Bolts of Concussions

A concussion is caused when the brain is shaken so forcefully that it hits the inside of the skull, resulting brain trauma.
Handfuls of studies have contributed to the growing concern of head injuries, particularly concussions, in the game of American football and other contact sports.

According to statistics from the National Center for Injury Prevention and Control, about 47 percent of high school football players sustain at least one concussion each season. And 35 percent of those who reportedly suffered from a concussion actually sustained two or more in the same season.

"Traumatic Brain Injury isn't an event that you recover from," said Pascrell. "It's an event that you live with for the rest of your life."

O'Shanick echoed Pascrell's statement and said that children are even more susceptible to adverse long-term effects of concussion.

"This is the right direction," said O'Shanick. "Children's traumatic brain injuries are more potentially devastating than adult since their brains are still developing until their mid-twenties. Damage at an early age harms the foundation for later brain growth and development."

Football Helmets Still Don't Offer Full Concussion Protection

While today's helmets have come a long way from their leather predecessors, they still do not fully protect from blows to the head.

"Helmets today are very good at protecting things like skull fractures and intracranial bleeding, which was a major cause of death in the 1960s," said Dr. Robert Cantu, director of sports medicine at Brigham and Women's Hospital and senior advisor to the NFL Head, Neck and Spine Committee. "In reality, what we need today is the science that will allow us to make a better helmet that will protect against concussion, and that science hasn't been done yet."

For reasons that remain unclear to experts, getting one concussion makes a person more prone to getting further concussions in the future. According to a study by Cantu and published in Neurosurgery, American football players who sustained three or more concussions were significantly more likely to develop depression had five times a greater chance of developing Alzheimer's disease.

"You can have the best helmet in the world, but if you're going head to head, you're still going to be at risk to get a concussion," said Dr. James Eckner, clinical lecturer in the department of physical medicine and rehabilitation at University of Michigan. "I don't want to discount efforts to make the game safer, but there are other things that also need to be done that would affect how people play."

Culture of Football Athletes May Need to Change to Avoid Concussion

Going along with that idea, in 2009, the NFL instituted a new policy where players could not return to a game or practice on the same day they exhibit concussion symptoms, including confusion, gap in memory, abnormal neurological exam, persistent headache or loss of consciousness.

And in 2010, the NFL took its policies one step further by charging hefty fines to players for particularly violent or flagrant hits, particularly blows to the head. Many doctors say they want to change the level of aggression that is such a part of football.

University of Michigan's Eckner said that a player can get a concussion -- even when he is not hit in the head. If the body is hit in a way that causes the player's head to accelerate and decelerate, no helmet can stop that concussion from happening.

"What really needs to happen is that the culture of athletes needs to change," said Eckner. "If you have kids being taught to lead with their heads, they're going to keep doing it."

Cantu said that creating a helmet that will better protect against concussions should be the highest priority in football safety.

"This legislation flames that priority," said Cantu. "I think it will facilitate even further discussion and funding. But how helmets relate to concussions is such a complex issue that we just don't have all the science today. Is that acceptable? No. Will it be that way in a year? I hope not."